System and method for removing cataract or other cells in an eye using water jet and suction

ABSTRACT

A system for removing cells from an interior portion of an eye, including a continuous passageway adapted to pass a fluid therethrough. A first cutting device is coupled to an exterior portion of the continuous passageway for dislodging cells from the interior portion of the eye. The first cutting device moves relative to the exterior portion of the continuous passageway due to the passing of the fluid through the continuous passageway.

This application is a continuation-in-part of U.S. patent applicationSer. No. 10/197,266, entitled “System and Method for Removing Cataractor Other Cells in an Eye Using Water Jet and Suction”, which is adivisional application of U.S. patent application Ser. No. 09/597,737,now U.S. Pat. No. 6,432,078, the entire contents of both of which areincorporated herein by reference.

CROSS-REFERENCE TO RELATED APPLICATION

Related subject matter is disclosed in copending U.S. patent applicationof Gholam A. Peyman entitled “System and Method for Thermally andChemically Treating Cells at Sites of Interest in the Body to ImpedeCell Proliferation”, Ser. No. 09/494,248, filed on Jan. 31, 2000, theentire contents of which is incorporated herein by reference.

FIELD OF INVENTION

The present invention relates to a system and method for treating andremoving cells in an interior chamber of an eye, such as in the lenscapsule of an eye. More particularly the present invention relates to asystem and method that treats cataract using a rotating device or bladeto kill and dislodge the cells forming the cataract from the eye withoutor substantially without causing protein denaturation to occur in theeye, and then using an aspirator or return tube for removing the fluidin the eye and the cells dislodged therefrom.

BACKGROUND OF THE INVENTION

Cataract is a condition that creates cloudiness in the lens of an eye,and is one of the major causes of blindness in the developing world.Cataract occurs in the lens of an eye and impedes the lens from focusinglight on the retina. The lens is composed of tightly packed lens fiberssurrounded by a collagenous elastic capsule. Beneath the lens capsuleare epithelial cells, which are responsible for the metabolic functionof the lens. Cataract may occur in any or all of these parts of thelens, which results in several different classifications of cataract,namely, subcapsular, cortical, and nuclear. To treat cataract, thecloudy portion of the lens, whether it is in the lens fibers, theepithelial, or both, or in any other portion of the lens, should besurgically removed. Generally, this is attempted by making an incisionin the corneal periphery (limbus) to enter the anterior chamber andremove the cataract.

A conventional method for removing cataract in the eye is the (manual)extracapsular technique. In this procedure, the eye is opened at thelimbus, and either a bent needle or any other curved sharp edgedinstrument or special forceps are employed to open the anterior lenscapsule and remove the nucleus within the capsule of the lens.Thereafter, the remaining cortical material is removed so as to leave aclear posterior lens capsule in the eye. The capsule provides a barrierbetween the anterior chamber and the vitreous cavity of the eye, as wellas a resting surface for an implanted artificial lens. However, thismethod results in an incision of about 7 millimeters being made, thuscreating an open system in the lens capsule. In other words, this methodmakes any fluid that is irrigated into the lens capsule difficult toretain and remove.

Other types of cell removing techniques, such as phacoemulsification,use a probe containing an ultrasonic wave generator, a rinsing fluid anda suction tip. In the phacoemulsification technique, an incision is madein the cornea of an eye and the probe is inserted. Compacted proteins ofthe lens nucleus are broken up by ultrasonic power and are emulsified bya rinsing fluid. The emulsified lens proteins as well as soft peripherallens proteins are removed from the eye by the suction tip.Phacoemulsification is generally considered superior to extracapsularsurgery because it only requires a surgical wound of about 2-3millimeters as opposed to about 7 millimeters. However, the problem withphacoemulsification is that opacification of the remaining capsule orposterior capsular opacification can occur. This opacification is causedby proliferation of the remaining lens epithelium, which this procedurehas failed to remove from the remaining capsule entity. An example ofthis type of technique is disclosed in U.S. Pat. No. 6,066,138 toSheffer et al., the entire contents of which are incorporated herein byreference.

Several similar techniques exist for treating and removing cells in thebody using an aspirator and/or an irrigator. For example, numerous typesof devices use a high-pressure waterjet to remove plaque deposits fromthe arterial walls of a patient.

Generally, these techniques use a tube with a high-pressure water jet,an evacuation tube, and a balloon. The balloon is inflated within theblood vessel to hold the tube in the desired position adjacent a plaquedeposit. The waterjet then ablates the plaque, and evacuates the ablatedplaque through the evacuation tube.

Although these conventional systems may be useful for removing tissue ina blood vessel, they are generally ineffective for removing cells in theeye. Specifically, the balloon in the conventional systems does notassist in removing cells or help in killing the cells to impede cellmultiplication. Additionally, the balloon's purpose in the existingapparatuses is to hold the device in place, thus making the movement ofthe device difficult and less effective for removing cells from inside alens capsule. Examples of these types of techniques are disclosed inU.S. Pat. No. 4,911,163 to Fina; U.S. Pat. No. 5,290,295 to Querals etal; U.S. Pat. Nos. 5,370,609, 5,496,267, and 5,785,675 all to Drasler etal; U.S. Pat. No. 5,439,446 to Barry; and U.S. Pat. No. 5,514,092 toForman et al., the entire contents of each are incorporated herein byreference.

Thus, there is a continuing need to improve the systems and methods forremoving cataract and preventing unwanted cell proliferation in the eye.

SUMMARY OF THE INVENTION

Accordingly, it is an object of the present invention to provide asystem and method for removing cells from an eye, such as cells in thelens epithelium, to eliminate or substantially eliminate posteriorcapsular opacification.

Another object of the present invention is to provide a system andmethod for separating and removing the lens epithelium from the lenscapsule substantially simultaneously.

Still another object of the present invention is to provide a system andmethod for removing cells from the eye that employs an apparatus havinga relatively small cross section, thus allowing for a relatively smallincision in the lens capsule for entry of the apparatus.

Still another object of the present invention is to provide a system andmethod for removing cells from the eye that creates a semi-closed systemwithin the lens capsule to allow for easy irrigation and aspiration offluid into and out of the eye.

Still another object of the present invention is to provide a system andmethod for removing cells from the eye that uses a rotatable portion toseparate the lens epithelium from the lens capsule and an aspiratingdevice or return tube to remove the lens epithelium and the fluid fromthe lens capsule.

The foregoing and other objects are basically obtained by providing asystem for removing cells from an interior portion of an eye, includinga continuous passageway adapted to pass for a fluid therethrough, and afirst cutting edge coupled to an exterior portion of said continuouspassageway for dislodging cells from the interior portion of the eye.The first cutting device moves relative to the exterior portion of thecontinuous passageway due to the passing of fluid through the continuouspassageway.

The foregoing objects are further obtained by providing a system adaptedfor insertion into an eye for removing cells from an interior portion ofthe eye, including a rotatable continuous passageway having at least oneaperture therethrough and being adapted to pass a fluid therethrough.The fluid flows adjacent the at least one aperture, which causes asuctioning force through the aperture. The at least one aperture isadapted to allow cells to pass therethrough and into the continuouspassageway, and the suctioning force is adapted to dislodge cells fromthe eye.

Other objects, advantages and novel features of the invention willbecome apparent from the following detailed description, which, taken inconjunction with the annexed drawings, disclose preferred embodiments ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring to the drawings which form a part of this disclosure:

FIG. 1 illustrates a system for removing cells according to anembodiment of the present invention, which is being inserted into thelens capsule of an eye shown in cross-section;

FIG. 2 is an enlarged view of a brushing device and irrigating andaspirating tubes of the system shown in FIG. 1 inserted into the lenscapsule of an eye;

FIG. 3 is an enlarged cross-sectional side view of the brushing deviceand the irrigating and aspirating tubes shown in FIG. 2;

FIG. 4 is an elevational end view of the brushing device and theirrigating and aspirating tubes taken along lines 4-4 in FIG. 3;

FIG. 5 is a cross-sectional view of the brushing device and theirrigating and aspirating tubes taken along lines 5-5 of FIG. 3;

FIG. 6 is a cross-sectional view of the irrigating and aspirating tubestaken along lines 6-6 of FIG. 3;

FIG. 7 is an enlarged view of the brushing device and irrigating andaspirating tubes of the system shown in FIG. 1 being inserted through aposterior chamber of the eye;

FIG. 8 is an enlarged view of the brushing device and irrigating andaspirating tubes of the system for removing cells as shown in FIG. 7with additional aspirating and irrigating tubes being inserted into theposterior chamber of the eye;

FIG. 9 illustrates a system for removing cells according to secondembodiment of the present invention, which is being inserted into thelens capsule of an eye;

FIG. 10 is an enlarged cross-sectional side view of the brushing deviceand the irrigating and aspirating tubes of the system shown in FIG. 9,in which the brush moves relative to the irrigating and aspiratingtubes;

FIG. 11 is an end elevational view of the brushing device and irrigatingand aspirating tubes taken along lines 11-11 of FIG. 10.

FIG. 12 is a cross-sectional view of the brushing device and irrigatingand aspirating tubes taken along lines 12-12 of FIG. 10;

FIG. 13 is a cross-sectional view of the irrigating and aspirating tubestaken along lines 13-13 of FIG. 10;

FIG. 14 is a cross-sectional side view of the system shown in FIG. 9,modified such that the brushing device oscillates relative to theaspirating and irrigating tubes;

FIG. 15 is a cross-sectional side view of the system of FIG. 9, modifiedsuch that the brushing device rotates relative to the aspirating andirrigating tubes;

FIG. 16 is a cross-sectional view of the system of FIG. 14 taken alonglines 16-16.

FIG. 17 is a cross-sectional side view of a brushing device and the highpressure fluid system according to a third embodiment of the presentinvention;

FIG. 18 is an elevational end view of the brushing device and the highpressure and return tubes taken along lines 18-18 in FIG. 17;

FIG. 19 is a cross-sectional view of the brushing device and the highpressure and return tubes taken along lines 19-19 of FIG. 17;

FIG. 20 is a cross-sectional view of the high pressure and return tubestaken along lines 20-20 of FIG. 17;

FIG. 21 is a cross-sectional perspective view of a high pressure fluidsystem according to a fourth embodiment of the present invention;

FIG. 22 is a partial cross-sectional detailed perspective view of a highpressure fluid system according to a fifth embodiment of the presentinvention which is adapted for use in the system shown in FIG. 21;

FIG. 23 is a cross-sectional perspective view of a second tankconfiguration for the high pressure fluid system of FIG. 21; and

FIG. 24 is a partial cross-sectional detailed perspective view of a highpressure fluid system according to a sixth embodiment of the presentinvention which is adapted for use with the system shown in FIG. 23.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring initially to FIGS. 1 and 2, a system 10 for removing cataracthas cleaning instrument such as a brush 12 coupled to one end of a tubeor catheter 14 and a manifold or joint 18 coupled to the other end oftube 14. Manifold 18 has two more tubes or catheters 22 and 24 extendingtherefrom, with tube 22 terminating into pump 20. Pump 20 is thencoupled to reservoir 26 through tube or catheter 28. Tube 24 extendsfrom manifold 18 to safety monitor 30, which is in turn is coupled toreservoir 32 by tube or catheter 34.

Tubes 22, 24, 28 and 34 are formed from synthetic material such assilicone, plastic or any other suitable material. Tubes 22, 24, 28 and34 can be flexible or rigid as desired and can be any tube or catheterthat is known to one skilled in the art.

Manifold 18 is formed from synthetic material such as silicone, plasticor any other suitable rigid material. Manifold 18 can be any manifoldthat is known to one skilled in the art and would allow multiple tubesto be interconnected. Additionally, manifold 18 is cable ofjoining twotubes 22 and 24, for example that have one passageway, to a tube thathas two passageways, such as tube 14.

Pump 20 is preferably a conventional reciprocating piston pump able tocreate a high pressure fluid jet, but may be any suitable pump.

Monitor 30 is a conventional monitor that would measure the pressure inthe tube 24 and compare this pressure with the pressure of the fluidbeing inserted into the eye. If these pressures were significantlydifferent, the monitor would be capable of shutting down the pump 20 andterminating the procedure. This may be necessary if some of thedislodged cells, or any other substance, were to become caught in a tubeand hinder the passage of fluid or other cells.

Reservoirs 26 and 32 are substantially similar and can be anyconventional reservoir for storing fluids as is known to one skilled inthe art.

As seen specifically in FIG. 2, brush 12 can be inserted into eye 36through cornea 38, into the anterior chamber 40, passing the iris 42 andthrough the surface 44 of lens 46, and thus into the lens capsule 48where the brush 12 contacts lens fiber 45 and/or epithelial 47.Alternatively, as shown in FIG. 7 and described in more detail below,the brush can be inserted into eye 36 through posterior chamber 49,behind iris 42, through the surface 44 of lens 46 and into lens capsule48, or into the eye 36 in any other suitable manner.

Brush 12 is preferably an expandable balloon made from a syntheticmaterial such as silicone, plastic or any other suitable expandablematerial, and has a fluid container allowing the balloon to be deflatedand inserted through a small incision in the eye 36 and subsequentlyinflated with a heated fluid, such as water, saline solution or anyother suitable fluid. However, brush 12 does not necessarily have to beexpandable, and may be a relatively small ball at the end of tube 14, oron an outer surface of tube 14, or can have any other configuration thatwould allow passage through a small incision in the eye 36. As seen inFIGS. 3-5, brush 12 is preferably cylindrical or substantiallycylindrical having an outwardly facing exterior surface 50 with anabrasive surface or bristles 52 extending therefrom, an inwardly facingexterior facing surface 54, and an interior surface 56 defining interiorchamber 58. However, brush 12 may be any suitable configuration thatwould enable it to couple to tube 14 and be inserted into the lenscapsule of the eye 38 or any other chamber in the eye 38.

Surface 54 of balloon 12 is preferably coupled to tube 14 and tube 60 bya bonding agent, such as glue or any other conventional method. However,balloon 12 does not necessarily have to couple to tubes 14 or 60 in thismanner, but can be coupled to one side of tube 14 and/or tube 60, orsurround only a portion of tube 14. Brush 12 can also be disposed on aseparate instrument attached to any suitable device that would allow theballoon to be inserted into an incision in eye 36.

Tube 60 extends through hole 62 in surface 56 of brush 12 and intochamber 58. Tube 60 has a through passageway 61 and is adapted to fillchamber 58 with a suitable heated fluid, such as water or salinesolution. As shown in FIGS. 3, 5 and 6, tube 60 is preferably coupledand parallel to tube 14 and is formed from a synthetic material such assilicone, plastic or any other suitable material.

The heated fluid that inflates brush 12 is preferably heated to atemperature of at or about 5 degrees Celsius or more above the normalbody temperature of 37 degrees Celsius, which causes cell death.Specifically, heating cells to a temperature of between at or about 42degrees Celsius and at or 60 degrees Celsius, or more preferably to ator about 45 to at or about 55 degrees Celsius, causes cell death.Heating cells to higher temperatures, such as at or about 60 degreesCelsius or higher, causes protein denaturation in the cells, whichresults in immediate cell death. The protein denaturation phenomenonalso causes coagulation of the cells in the heated area and becomesdifficult to remove, because the cells adhere tightly together.

Tube 14 may be made from a synthetic material such as silicone, plasticor any other suitable material and may have a rigid portion 64, as seenin FIGS. 1 and 2, that allows for manipulation of the brush 12, and aflexible portion 66 that allows for easier use and storage. As seen inFIG. 3-6, tube 14 preferably has an inner surface 68, an outer surface70, a distal end 71, and a wall 72. Wall 72 and surface 68 defining twoequal or substantially equal through passageways 74 and 76. However,passageways 74 and 76 do not have to be substantially equal, and may beany size or suitable configuration that would allow a fluid to passtherethrough. Additionally, passageways 74 and 76 do not necessarilyneed to be disposed in the same tube, but may be two separate tubes. Asshown in FIG. 3, passageway 74 is adapted to pass a fluid or liquid 78through orifice 75 at distal end 71 and irrigate an interior chamber ofthe eye, while passageway 76 is adapted to allow fluid to pass throughorifice 77 at distal end 71 and aspirate an interior chamber of the eye,removing any excess fluid or dislodged cells.

The fluid 78 is preferably a pressurized jet of water, saline solutionor any other suitable fluid that is irrigated into the lens capsule 48or any other area of the eye 36 using pump 20. However, the fluid 78 isnot necessarily under high pressure and be under any pressure includedsubstantially zero. Fluid 78 may be a normal balanced salt solution, a2% alcohol solution, heated fluid of at or about 20 degrees Celsius toat or about 60 degrees Celsius (more preferably to at or about 40-50degrees Celsius, even more preferably to at or about 42-43 degreesCelsius). Heating fluid to at or about 42-42 degrees Celsius is theoptimum temperature for killing the cells in the interior of the eyewithout causing protein denaturation in the remaining healthy cells.Additionally fluid 78 can be an enzyme, such as plasmin, tissueplasminogen activator, urokinase, and chondrotinase, or antibiotics suchas, aminoglycosides and gentamycin. Fluid 78 may be one or more of thesesubstances used independently or sequentially to damage the lensepithelium. Enzymes may be used to loosen up the lens epithelium. Thealcohol solution is preferably to kill the desired epithelial cells andfurther loosen their attachment to the lens capsule. Heated water orsaline may be used to denaturize the cell's protein and wash out thelens epithelium. While the use of aminoglycoside or gentamycin help thecells damaged membrane and promote infection prophylaxis. The use ofthese solutions in a sequentially removes the lens fiber and theepithelial from the lens capsule without causing protein denaturization.In addition, tubes 22, 24, 28 and 38 preferably have one passageway asit is necessary to only move fluid or liquid in one directiontherethrough, but can have two passageways in a substantially similarconfiguration to tube 14.

Operation

Initially, a relatively small incision (approximately 2-3 mm) ispreferably made through the limbus, but may be through any other portionof the cornea 38 or of the eye 36 using a lancet or any other suitableknife. The lancet or knife is preferably a separate instrument, but maybe attached to the brush 12 or tube 14 or any other suitable device.Another relatively small incision of a predetermined size, similar tothat above, is made in the surface of the lens capsule. As seen in FIGS.1 and 2, the brush 12 and tubes 14 and 60 are then inserted through theincisions and the brush is inflated with an appropriate fluid. The fluidis of a temperature, described above, that heats the balloon to adesired temperature and kills the cells with which it comes intocontact. Additionally, the abrasive surface or bristles 52 on the brushmay be used to scrape and dislodge the lens epithelial 47 or otherunwanted cells. Pump 20 is then activated, pumping water from thereservoir 26, through the manifold 18 and into passageway 74 of tube 14.The pump preferably creates pressurized jet of fluid 78, which dislodgesand kills the desired cells and removes most of the lens fibers 45 andepithelium 47 in the lens capsule 48. However, the pump 20 may be usedto pump the fluid 78 at any pressure, including substantially zero. Asdescribed above, the fluid may be any of the stated substances or may bea combination of the substances inserted in any desired order. Insertinga sequence of separate fluids may be accomplished by removing receptacle26 replacing it with another containing a desired substance, oralternatively, there may be multiple reservoirs in parallel that can beactivated manually, depending on which fluid is to be infused into theeye 36.

The relatively small incision in the lens capsule 48 preferably resultsin a semi-closed system in which the dislodged cells and the irrigatedfluid are contained and removed through the aspirating passageway 76 oftube 14. However, it is not necessary for the system 10 to operate in asemi-closed system (particularly if the irrigated fluid is notpressurized). The suction needed for this passageway 76 is automaticallycaused by the pressure differential due to the increased pressure in thelens capsule 48 and the pressure in the passageway 76. The fluid passesthrough monitor 30 and into the reservoir 32.

The brush 12 and tubes 14 may then be removed and the lens capsule 48filled with a transparent biocompatable elastic substance or a portionof the lens capsule 48 can be removed for implantation of a standardintraocular lens, in the remaining capsular portion. For a furtherdescription of intraocular lenses see U.S. Pat. Nos. 4,581,031 and4,666,446, both to Koziol et al., the entire contents of which areherein incorporated by reference.

Embodiment of FIG. 8

A system 110 according to another embodiment of the present inventionwill now be described. As seen in FIG. 8, system 110 has tubes 114 and116. Tube 114 is an irrigation tube that is formed from material andproduces a water jet that is substantially similar to the passageway 74described above, the description of passageway 74 of tube 14 and fluid78 is applicable to tube 114. Tube 116 is substantially similar to andformed from similar material as aspirating passageway 76 describedabove, the description of passageway 76 of tube 14 and fluid 78 isapplicable to tube 116. System 110 can be used in conjunction with asystem similar to system 10 described above, or it may be used alone.Operation of system 10 is similar to 110 and the description of system10 is applicable to system 110.

In system 110, it would be necessary to cut and dislodge vitreous cellsusing a cutting mechanism, such as a knife or other device, as is knownto one of ordinary skill in the art. Once the cells have been dislodged,system 110 could then be inserted into a chamber in the eye. As seen inFIG. 8, system 110 injects fluid 78 into the vitreous 118 on an eye 36irrigating cells therein. These dislodged cells and the fluid injectedinto the eye are then aspirated using tube 116, in a substantiallysimilar manner as described above for aspirating passageway 76.

Additionally, system 110 or system 10 described above can have a fiberoptic cable (not shown) attached to tube 114 or tube 116 to illuminatethe area in which the sells are to be removed. The fiber optic cabledoes not necessarily have to be coupled to a tube, and may be a separateinstrument. System 110 may also have a guide wire (not shown) to addrigidity and control to system 110.

Embodiment of FIGS. 9-16

A further embodiment of the present invention will now be described. Asseen in FIGS. 9-13, system 210 has a brush 212 and a tubes 214 and 260substantially similar to brush 12, tube 14, and tube 60, respectively,and any description of brush 12 and tubes 14 and 60 above applies tobrush 212 and tubes 214 and 260. Additionally, brush 212 is disposed ina system substantially similar to system 10 and the description ofsystem 10 applies to system 210. However, as seen in FIG. 9, thisembodiment employs a motor 216 as described in more detail below.

As seen in FIGS. 10-12, tubes 214 and 260 are disposed in a cavity orchamber 216 of outer tube 218. Brush 212 is coupled to tube 218 in thesame manner as brush 12 is coupled to tube 14 described above. Tube 218is made from a synthetic material such as silicone, plastic or any othersuitable material and has a hole 220 that along with hole 262 of brush212 defines through passageway 222. Open end 261 of tube 260 is adaptedto align with through passageway 222 and allows a heated fluid such aswater to inflate brush 212. The heated fluid used to inflate brush 212is substantially similar to the heated fluid to inflate brush 12 and thedescription thereof is applicable to this embodiment.

As seen in FIG. 14, outer tube 218 has a series of teeth 224 coupled tothe exterior surface. These teeth engage a gear 226 coupled to electricmotor 217, the combination adapted to reciprocate tube 218 and brush 212connected thereto in the directions of arrows 227. Electric motor 217may be adapted to oscillate brush 212 at frequencies ranging from aboutone cycle per second up to several thousand cycles per minute. Thismotion or movement allows the brush to move back and forth with respectto tube 212 and the remainder of the system, and assist in dislodginglens fiber 45 and epithelial cells 47 from the lens capsule 48.

As seen in FIG. 14, electric motor 217 is electrically coupled to acontroller 219 that controls the frequency of the oscillations of brush212 and can turn the electric motor 217 on and off.

As seen in FIGS. 15 and 16, a gear 228 is coupled to and surrounds tube218 and engages gear 230 that is connected to electric motor 217. Thiscombination allows tube 218 and the brush 212 coupled thereto to rotatewith respect to tubes 214 and 260 and the remainder of the system andassist in dislodging lens fiber 45 and epithelial cells 47 from the lenscapsule 48. Electric motor 217 may be adapted to rotate brush 212 at arate ranging from about one rotation per second up to several thousandrotations per minute.

As seen in FIGS. 15 and 16, electric motor 217 is electrically coupledto a controller 219 that controls the rate of the rotation of brush 212and can turn the electric motor 217 on and off.

These two examples of motion of the tube 218 and the brush 212 withrespect to the tube 214 are examples only and do not limit the brush andtube from other movement or combinations of movement, such as a gearconfiguration that would allow the brush to simultaneously orsequentially rotate and/or oscillate.

Embodiment of FIG. 17-20

A further embodiment of the present invention will now be described. Asseen in FIG. 17-20, system 310 has a brush 312 and tubes 314 and 360.Brush 312 and tube 360 are substantially similar to brush 12 and tube60, respectively, and any description of brush 12 and tube 60 aboveapplies to brush 312 and tubes 314 and 360. Additionally, brush 312 isdisposed in a system substantially similar to system 10 and may bedisposed in a system substantially similar to system 210 and thedescriptions of systems 10 and 210 apply to system 310.

Tube 314 may be made from a synthetic material such as silicone, plasticor any other suitable material. Tube 314 preferably has an inner surface368, an outer surface 370, a closed distal end 371, a wall 372, andpreferably two apertures 380 and 382 extending from outer surface 370 toinner surface 368. Wall 372 and surface 368 define two equal orsubstantially equal through passageways 374 and 376. However,passageways 374 and 376 do not have to be substantially equal, and maybe any size or suitable configuration that would allow a fluid to passtherethrough. Additionally, passageways 374 and 376 do not necessarilyneed to be disposed in one tube and may be individual tubes eitherseparated or coupled together. Aperture 380 extends through outersurface 370 and into passageway 374 and preferably, aperture 382 extendsthrough the outer surface 370 and into passageway 376. However, it isnot necessary to have aperture 382, as described below. Apertures 380and 382 may be any size or configuration that would allow fluid 378 andcells within the eye 36 to pass therethrough. Apertures 380 and 382 mayalso be placed anywhere along the length or periphery of tube 314 orthere may be multiple apertures extending through surface 370 and intoeach passageway 374 and 376, as deemed necessary. Wall 372 extendssubstantially the entire length of tube 314, however it does not extendto and abut end 371. Wall 372 terminates a predetermined distance fromend 372 leaving a passage 375 between passageways 376 and 374, allowingfluid and lens cells or any other cells to pass from passageway 374 topassageway 376.

Similar to system 10 above, brush 312 and tube 314 are inserted into asemi-closed lens capsule 48 and brush 312 is inflated and used todislodge cells, such as lens epithelial 47 or lens fiber 45 or any otherdesired cells. Using a high pressure pump substantially similar to pump20, described above for system 10, a fluid 378 is pumped into tube 314,or more specifically passageway 374, under high pressure. Fluid 378 issubstantially similar to fluid 78 and the description thereof applies tofluid 378. As fluid 378 flows through passageway 374 it passes aperture380 creating suction at aperture 380, while allowing no or minimal fluidto pass through the aperture 380. The suction at aperture 380 drawsfluid (i.e. the minimal fluid that passes through aperture 380 or fluidthat passes through aperture 382, described in more detail below) andcells into passageway 374. The cells that are drawn in may be any cellsdislodged or cellularly attached in the eye. The cells may be epithelialcells, cell fiber, or any other cells to be removed from the interior ofthe eye. Once the cells are drawn into passageway 374 they are cut ordislodged from the lens capsule 48 or any other portion of the eye bythe high pressure fluid flow and similarly swept away. The flow contactsthe closed end 371 and passes through passageway 375 and into passageway374, where it returns to reservoir 32, if there is no aperture 382.

Preferably, however, there is another aperture 382 in passageway 376. Inwhich case, since the fluid in passageway 376 will not be under highpressure, some of the fluid and/or cells may escape through aperture382, most of the fluid and cells return to reservoir 32, similar to thesystems 10 and 210 described above. However, the material and fluid thatescapes through aperture 382 is released into the semi-closed lenscapsule system and returns into the suction aperture 380. As thisprocess repeats itself, a decreasing number of the cells from the eyeescape back into the lens capsule until virtually no cells escape fromthe aperture 382.

The use of the high pressure system to cut and cycle the fluid 378 maybe used before, after or during the use of brush 312. It is notnecessary for the use of the tube to follow the use of the brush andthey may be alternately used in any order, any number of times.

Additionally, it is possible to use tube 314 without brush 312, in thelens capsule 48, as described above, or to remove vitreous in the eye asdescribed in the embodiment of FIG. 8. If tube 314 were used to removevitreous, it would not be necessary to cut or dislodge the vitreousprior to insertion of tube 314 into the eye, as described above. Thehigh pressure water system would cut and dislodge the vitreous andremove the cells therefrom.

The features of systems 110, 210, and 310, which are similar to system10 are identified with like reference numbers. The same description ofthose similar features is applicable.

Embodiments of FIGS. 21 and 22

As seen in FIGS. 21 and 22, system 410 is a device for removingcataract, as described herein. System 410 includes a housing 412, anirrigating or delivery tube or portion 414 and aspirating or return tubeor portion 460 and a tank system 416. The system 410, similar to theembodiments described above, is a high pressure fluid delivery systemthat circulates fluid from tank 436 through tube 414 back through tube460 and into tank 438. Preferably, tubes 414 and 460 define a continuouspassageway that rotates relative to an internal portion or chamber ofthe eye and housing 412.

Housing 412 is preferably plastic and has an upper portion 418 and alower portion 420. Upper housing portion 418 is preferably a plasticcylindrical tube that has a first open end 422 and a second open end424. Additionally, upper housing portion 418 extends upwardly or awayfrom lower housing portion 420. Upper housing portion 418 has a diameterthat allows tubes 414 and 460 to pass therethrough, but is still smallenough to pass through an opening (similar to any opening describedabove) in the eye. Lower housing portion 420 is preferably substantiallycylindrical and houses tank system 416.

Lower housing portion 420 preferably has a larger diameter than theupper housing portion; however, the relative diameters between the twohousing portions can be any ratio desired. For example, the diameterscan be substantially the same or the upper housing portion can have adiameter that is larger than the lower housing portion. Lower housingportion 420 has a first closed end 426 with a first end surface 428 anda second end 430 with a second end surface 432. Second end 430preferably has an opening 434 therein, which communicates with thesecond open end of upper housing portion 424.

Lower housing portion 420 is preferably large enough to house tanksystem 416, which includes a first tank 436 and a second tank 438. Eachtank is shown in FIG. 21 as being substantially cylindrical; howevereach tank 436 and 438 can be any shape desired, as long as they are eachat least between at or about 1 millimeter and at or about 10 milliliterin volume, or as large or small as necessary to adequately irrigateand/or aspirate the eye during the procedure described herein. Each tankis preferably located on a platform or surface 440. Surface 440 ispreferably mechanically coupled to an engine or motor 442, which iscapable of rotating surface 440 at a high speed, such as at or about1000 rpms to about 50,000 rpms or about 60,000 rpms or more, which inturn rotates tanks 436 and 438, and tubes 414 and 460. First end 426 hasa switch 433 thereon that is electrically coupled to motor 442, whichcan manually turn motor 442 on and/or off. It is noted that thedescribed and shown device and method of rotating tanks 426 and 438 ismerely exemplary and the tanks can be rotated in any manner desired, andnot necessarily in the manner described herein, as long as the result ofrotating the tanks is the high speed rotation of tubes 414 and 460.

Tank 436 has an opening 444 in the top surface thereof, to which abottom end of tube 414 is connected, and tank 438 has an opening 446 inthe top surface thereof, to which the bottom portion of tube 460 isconnected. However, it is noted that the openings can be placed in anypositioned relative to the top and bottom of the tanks 436 and 438.

Preferably, as irrigation tube 414 extends outwardly from tank 436, itpasses through opening 434 in lower housing portion 420 and into upperhousing portion 418. Upper housing portion 418 is preferably acylindrical plastic tube; however, portion 418 can be any shape ormaterial desired, as long as it is capable of protecting tubes 418 and460. Furthermore, it is not necessary to have upper housing portion 418,although it is generally preferable since, housing portion 418 canprotect system 410 from inadvertently tangling with the inner portion ofthe eye during rotation of the tubes 414 and 460.

As tube 414 extends upwardly through the passageway 450 defined throughupper housing portion 418, tube 414 intertwines with tube 460. Duringoperation, each tube 414 and 460 rotates around central axis 448 thatextends substantially through the center of upper housing portion 418,as indicated by arrow 451. By intertwining the tubes in this manner,circulation of fluid through the tubes is achieved. However, it is notedthat it is not necessary to intertwine the tubes 414 and 460, and theycan extend substantially parallel to each other, as shown in FIG. 22.The fluid can be any suitable fluid, such as, water, saline solution orany other fluid described above.

A portion of tube 414 extends upwardly and out of the first open end 422of upper housing 418, as does a portion of tube 460. Tubes 414 and 460are connected adjacent the first end of the upper housing 418 by acurved, rounded or arced end portion 452. Preferably, curved portion 452is positioned outside of passageway 450; however, a portion of curvedportion 452 can be received within passageway 450, even substantiallyall of curved portion 452 can be received in passageway 450, as long asat least the end 454 of curved portion 452 extends beyond end 422.

Curved portion 452 has at least one opening 456 and preferably severalopenings 456, up to as many as preferable therein. Openings 456 extendfrom the outer surface of curved portion 452 to the passageway definedtherein for the passage of a fluid therethrough. Additionally, theopenings allow fluid and cells from the interior portion of the eye topass into the curved portion, as indicated by arrows 458, and allowfluid from the interior portion of the curved portion to pass into theeye. Furthermore openings 456 allow fluid originally from the eye topass out of the curved portion and back again into the interior portionof the eye, as indicated by arrows 462.

Preferably, each tube 414 and 460 and curved portion 452 has a diameterbetween about 200 microns to about 500 microns, but each can be up toabout 3 mm in diameters. Preferably, the entire overall dimension oftube 414 and 460 is at or about 800 microns to at or about 1000 micronsin width; however, the entire width can be about 3 mm or greater, ifdesired. The smaller diameter allows greater circulation of the fluidwithin the tubes.

Operation

During a procedure to eliminate cells from an interior portion of theeye, such as the removal of cells forming the cataract from the eyewithout or substantially without causing protein denaturation to occurin the eye, the system 410 is inserted into an opening formed in theeye, as described above. The system is inserted into the lens of the eyeor any other interior portion or chamber of the eye desired, and switch433 is activated to turn the motor 442 on, which in turn rotates thetanks 436 and 438 and the tubes 414 and 460. It is noted that that thetubes do not necessarily need to rotate in this specific manner (i.e.,the manual switch to turn on the motor to rotate the tanks), and can berotated in any manner desired. For example, the switch can be timecontrolled or activated/deactivated at certain immediate environmentalconditions, such as activated when surrounded by certain biologicalconditions or material in the eye.

The high pressure fluid can be circulated through the entire system inany conventional manner, such as high pressure air, a pump or in anyother manner desired. The high speed rotation of the tubes inducesfurther circulation of the fluid through the system. It is noted thatthe circulation of the fluid can be based solely on the high speedrotation of the tubes and therefore, no external pressure device wouldbe needed. As the fluid passes internally adjacent openings 462, fluidand cells from the internal portion of the eye pass through the openings462 and into the passageway defined by the tube, due to the vacuumcaused by the fluid passing the opening, as described above. Therotation of the tubes, along with the force of the high pressure fluidsevers the undesired cells from the interior portion of the eye, thusremoving any undesired or cataract cells. The fluid and cells thentravel back through tube 460 and into tank 446.

Some fluid (both from tank 436 and from the eye) and some cells arerecirculated into the eye through at least one of the openings 462.After a predetermined amount of time, substantially all dislodged andundesired cells are removed from the interior portion of the eye andinto tank 438.

Furthermore, any description of the above embodiments is applicable tosystem 410, except the differences specifically described herein.

Embodiment of FIG. 23

As shown in FIG. 23, the tanks 436 a and 438 a do not need to rotatethemselves, as long as they allow tubes 414 a and 460 a to rotate, asindicated by arrow 470. Each tank 436 a and 438 a is substantially ringshaped, with a rectangular cross section. As shown in FIG. 23, tank 436a is positioned to overlie or lie on top of tank 438 a; however, it isnoted that the tanks can be positioned in any manner relative to eachother, as long as tubes 414 a and 460 a are allowed to rotate.

Tanks 414 a and 460 a each has an inner wall 472 a and 474 a,respectively, that are coupled to tubes 414 a and 460 a, respectively,through openings 476 and 478, respectively. Furthermore, each inner wall472 a and 474 a is adapted to move or rotate relative to the rest of arespective tank, and therefore rotate with the tubes 414 a and 460 a,respectively. As seen in FIG. 23, the rotation of the inner wall of eachtank allows the tubes 414 a and 460 a to rotate without a tank rotationstructure, as described above.

Tubes 414 a and 460 a are preferably coupled to a supporting structure480, which has a gear 482 thereon. Gear 482 meshes with gear 484, whichis in turn coupled to motor 490. Motor 490 is electrically coupled toswitch 433, which is adapted to turn on the motor 490, as describedabove. However, it is not necessary to use this specific configurationfor rotating the walls 474 a and 472 a and the tubes 414 a and 460 a,and any gear/motor structure desired can be used.

It is understood that the tank rotation configurations described aboveare merely exemplary and any structure that would allow continual full360° rotation or even partial rotation (i.e. greater than about 30°) ofthe tubes 414 and 460 and 414 a and 460 a is desirable. For example,each tank structure described above can allow reciprocating rotation,wherein the tubes travel in an arcing direction for a predeterminedlength of an arc, such as 45°, 90°, 180°, or any other arc desired. Itis noted that the reciprocating movement of the tubes does notnecessarily need to be less than 360°, and it can be more or much morethan 360°.

Additionally, the tubes can have an initial configuration with the endadjacent the tanks and/or the tanks themselves situated in a fixedposition (i.e., the tanks do not rotate), and begin in a positionsimilar to that described and shown in FIG. 22. In this embodiment, thetubes would be flexible and would wind about each other, resulting in aconfiguration similar to that shown in FIG. 21. At a predetermined timeor after a predetermined number of rotations, the tubes would rotate inthe opposite direction, and thus begin unwinding. The tubes would thenpass through the configuration shown in FIG. 22 and wind together in theopposite direction for a predetermined time or a predetermined number ofrotations, again ending in a configuration similar to that described andshown in FIG. 21, where the procedure would be repeated as many times asdesired. This would allow the tubes to rotate relative to the interiorportion of the eye and/or the housing without having the rotatingtank/tank wall configurations described above.

Embodiment of FIG. 24

FIG. 24 shows another system 510 for removing or eliminating cells froman interior portion of an eye, in which the tubes 514 and 560 arecoupled together by an end portion 554, the end portion, having aninternal propeller or cutting edge 560 and an external propeller orcutting edge 564. Tubes 514 and 560 and end portion 554 define acontinuous passageway 555.

Tubes 514 and 560 are preferably plastic and substantially similar inconstruction to tubes 414 and 460, respectively, and any descriptionthereof is applicable to this embodiment; however, it is noted that thattubes 514 and 560 preferably do not rotate relative to the interiorportion of the eye or each other. Furthermore, each tube 514 and 560 ispreferably about 50 microns to about 1500 microns in diameter and theoverall width of the portion of system 510 that is inserted into the eyeis about 200 microns to about 3000 microns. It is noted that tubes 514and 560 do not necessarily need to be spaced apart and can be coupled toeach other, as long as the internal passageway defined by each tuberemains separate and distinct from the other tube.

End portion 554 preferably defines an inner cavity 564 that has a firstcurved or arcuate end 566 and a second curved or arcuate end 568. Theinner cavity houses propeller or rotating blade 560 that is adapted torotate relative to the inner cavity and is coupled to the first end 566using mechanism 570. Mechanism 570 is preferably merely a stand or rod572 that is attached to end 566 on one end and is attached to thepropeller 560 on the other end. The propeller 560 preferably rotates dueto the flow of high pressure fluid through the system.

First end 566 has openings 562 therein. Openings 562 are forsubstantially the same purpose as openings 462, and therefore will notbe described herein. Second propeller or rotating blade 564 is attachedto the outer surface of end 566 via mechanism 574, which issubstantially similar to mechanism 570. Preferably, propeller 564rotates relative to the outer surface of end 566 and the interiorportion of the eye due to the flow of fluid through the tubes 514 and560. More specifically, preferably propellers 560 and 564 aremechanically or electrically coupled together through mechanisms 570 and574 in any conventional manner, and therefore as fluid flows through thetubes, it rotates propeller 560, which in turn rotates propeller 564.

However, it is not necessary to have both propellers 560 and 564. Forexample, it is possible to have only one propeller 560 or 564. In thecase of only propeller 560, the fluid would cause the propeller torotate as described above. On the other hand, in the case of onlypropeller 564, the fluid would pass a secondary device (not shown) thatwould be linked or mechanically or electrically coupled to propeller 564in any conventional manner that would cause the propeller to rotate.Furthermore, it is noted that the description herein is not limited toone external and one internal propeller. There can be multiple internaland/or multiple external propellers, if desired

Operation

System 510 is inserted into an interior portion of the eye, as describedfor the embodiments above. Fluid is passed through the tube 514 in asimilar manner as also described above. The fluid passes adjacentopening 562, causing interior eye fluid and cells to pass therein. Thefluid substantially simultaneously passes propeller 560 to rotate.Interior eye cells are then severed from the interior portion of the eyedue to the force of the high pressure fluid and the cutting action ofthe propeller 560.

Additionally, propeller 560 causes propeller 564 to rotate, which sinceit is external to system 510 contacts portions or cells in the interiorof the eye, and cuts or severs these cells, which are in turn suckedinto the openings 562.

As with the systems described above, the openings allow cells and/orfluid to both enter the system and leave the system and are thereforecirculated through the eye and the system 510. However, after apredetermined amount of time all desired dislodged cells are removedthrough the openings 562.

Furthermore, any description of the above embodiments is applicable tosystem 510, except the differences specifically described herein.

Any description herein using up, down, upper, lower, or any otherorientation is merely tto described elements of the herein describedembodiments relative to each other and are not meant to limit thestructure or invention in any way.

While a few specific embodiments have been chosen to illustrate theinvention, it will be understood by those skilled in the art thatvarious changes and modifications can be made therein without departingfrom the scope of the invention as defined in the appended claims.

1. A system for removing cells from an interior of an eye, comprising: an instrument adapted to pass through an incision in an eye and having a surface adapted to contact and dislodge cells from said interior of the eye; and a first tube system, adapted to pass through one of said incision and another incision in the eye, and having a first passageway for infusing a fluid into the eye to dislodge cells therein, and a second passageway for aspirating said fluid and dislodged cells out of the eye.
 2. A system according to claim 1 wherein: said instrument includes a fluid container, adapted to receive and contain a heated fluid therein.
 3. A system according to claim 2, further comprising: a second tube system coupled to said instrument, and having a third passageway for inserting said heated fluid into said fluid container.
 4. A system according to claim 1, wherein: said instrument is adapted to oscillate relative to said first tube.
 5. A system according to claim 1, wherein: said instrument is adapted to rotate relative to said first tube.
 6. A system according to claim 1, further comprising: a pressurizing device from introducing said fluid under pressure into said passageway.
 7. A system according to claim 1 wherein: said fluid comprises a saline solution.
 8. A system according to claim 1, wherein: said fluid includes an alcohol solution.
 9. A system according to claim 1, wherein: said instrument and said first tube system are adapted to be inserted into a lens capsule of said eye.
 10. A system according to claim 1, wherein: said instrument includes a brush.
 11. An instrument for removing cells inside of an eye, comprising: an inflatable instrument having an abrasive surface and a hole therein; a first tube coupled to said inflatable instrument and having a chamber therein; a second tube adapted to be positioned within said chamber of said first tube having a first passageway for infusing a fluid inside of the eye to dislodge cells therefrom, and a second passageway for aspirating said fluid and dislodged cells out of the eye; and a third tube adapted to be positioned within said chamber of said first tube and in said hole in said surface of said instrument, and adapted to inflate said inflatable instrument; wherein said first tube is movable relative to said second and third tubes.
 12. An instrument according to claim 11, wherein: said first tube is adapted to oscillate relative to said second and third tubes.
 13. An instrument according to claim 11, wherein: said first tube is adapted to rotate about said second and third tubes.
 14. An instrument according to claim 11 wherein: said third tube is adapted to insert a heated solution into said inflatable instrument to inflate said inflatable instrument.
 15. An instrument according to claim 11, wherein: said inflatable instrument includes a brush.
 16. A method for removing cells from inside of an eye, the method comprising the steps of: inserting into said eye a first instrument having a surface which contacts and dislodges cells from an interior portion of the eye; inserting into said eye a second instrument having a first tube adapted to irrigate a fluid; inserting into said eye a third instrument having a second tube adapted to aspirate said fluid and cells from inside of said eye; irrigating said fluid through said first tube to dislodge cells from a portion inside said eye; and aspirating said fluid and cells from inside said eye through said second tube.
 17. A method according to claim 16, further comprising the step of: creating at least one incision in a surface of said eye; and wherein said inserting steps insert said second and third instruments into the same said incision or different incisions in said surface of said eye.
 18. A method according to claim 16, wherein: said inserting steps insert said second and third instruments into a capsule of said lens of said eye.
 19. A method according to claim 16, wherein: said inserting steps insert said second and third instruments through a cornea and an anterior chamber of said eye.
 20. A method according to claim 16, wherein: said inserting steps insert said second and third instruments through a posterior chamber of said eye.
 21. A method according to claim 16, wherein: said irrigating step irrigates said fluid under pressure in said first tube.
 22. A method according to claim 16, wherein: said first and second instruments are coupled together, such that said inserting steps are performed substantially simultaneously;
 23. A method according to claim 16, wherein: said first instrument includes a brush.
 24. A method according to claim 23, further including the step of: moving said brush relative to said eye to dislodge said cells from said portion of said eye.
 25. A method according to claim 16, wherein said moving step includes: oscillating said abrasive instrument relative to said eye to dislodge said cells from said portion of said eye.
 26. A method according to claim 16, wherein said moving step includes: rotating said abrasive instrument relative to said eye to dislodge said cells from said portion of said eye.
 27. A system adapted for insertion into an eye for removing cells from an interior portion of the eye, comprising: a rotatable continuous passageway having at least one aperture therethrough and being adapted to pass a fluid therethrough, said fluid flowing adjacent said at least one aperture and causing a suctioning force therethrough, said at least one aperture adapted to allow cells to pass therethrough and into said continuous passageway, and said suctioning force being adapted to dislodge cells from the eye.
 28. A system according to claim 27, wherein said continuous passageway has a first portion and a second portion, said first and second portions being coupled together by a rounded end portion.
 29. A system according to claim 28, wherein said first and second portions are substantially parallel.
 30. A system according to claim 28, wherein said rounded end portion has said at least one aperture located therein.
 31. A system according to claim 28, wherein said first and second portions are intertwined.
 32. A system according to claim 28, further comprising first and second tanks couple to the first and second portions, respectively.
 33. A system according to claim 32, wherein said first and second tanks rotate with the first and second portions.
 34. A system according to claim 32, wherein said first and second tanks are substantially ring shaped and have first and second inner walls, respectively.
 35. A system according to claim 34, wherein said first and second portions and coupled to the first and second tanks at said first and second inner walls, respectively, and said first and second inner walls rotate with said first and second portions.
 36. A system according to claim 28, wherein said first portion is adapted to convey liquid to the eye and said second portion is adapted to convey liquid out of the eye. 37-50. (canceled) 